Forms Incorporated by Reference

 

DEPARTMENT OF FINANCIAL SERVICES

OIR – Insurance Regulation

RULE NO.: RULE TITLE:

69O-194.030Forms Incorporated by Reference

NOTICE OF CHANGE

Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 43 No. 54, March 20, 2017 issue of the Florida Administrative Register.

69O-194.030 Forms Incorporated by Reference.

The following forms are incorporated into this rule chapter by reference to implement the provisions of Chapter 641, Part III, Florida Statutes: These changes are being made to address concerns expressed by the Joint Administrative Procedures Committee.

 

TitleForm Number

(1) Application for Certificate of Authority

               Prepaid Health Clinic                                       OIR-C1-483http://www.flrules.org/Gateway/reference.asp?No=Ref-08305 (Rev 5/17)

(2) Annual ReportsOIR-A2-949(07/04) and OIR-A2-950(07/04)482(1/90)

(3) Authority  for to Release of InformationOIR-C1-450(5/00) (8/89)

(4) Biographical Statement and AffidavitOIR-C1-1423 422(8/14)(8/89)

(5) Abbreviated Biographical StatementOIR-449(5/89)

(6) Consent and Agreement in re Service of

Process Consent  & AgreementOIR-C1-144(06/2004)(1/90)

(7) Statement of Acquisition, Merger or Consolidation

of a Specialty  Insurer Pursuant to

Florida Statutes 628.461, 628.4615.OIR-C1-448(12/05)(5/89)

(8) Fingerprint Payment and Submission Procedure     OIR-C1-938(5/2013)

(9) Instructions for Investigative Report                 OIR-C1-905(2/15)

These forms shall become effective on the date this rule becomes effective. Copies of the forms may be obtained from the Officer of Insurance Regulation’s web site: http://www.floir.com/iportal., Bureau of Specialty Insurers, Larson Building, Tallahassee, FL 32399-0300.

Rulemaking Specific Authority 641.403 FS. Law Implemented 624.424, 624.501(26), 641.402, 641.405, 641.41, 641.416 FS. History–New 6-25-90, Formerly 4-69.081, 4-194.030 Amended ______________.